Republicans look to alter reform law's mandatory spending

Democrats on the health subpanel accused Republicans of railing against a legislative tactic they themselves used in a Medicare reform bill they passed in 2003, which created a new prescription drug benefit for seniors.

“Every member of this committee has a history of voting for both mandatory spending and discretionary spending,” said Rep. Henry Waxman (D-Calif.), the Energy and Commerce Committee’s ranking member. “In fact, a Republican-led Congress passed legislation that included over $400 billion of mandatory spending that was not paid for in the Medicare drug bill.”

Former Rep. Ernest Istook (R-Okla.) told the health panel that the 2003 Medicare reform law was different because it changed spending for a permanent program.
“It was simply changing the definition of what’s covered as opposed to providing new appropriations,” Istook told the committee.

The healthcare reform programs targeted by Republicans on Wednesday include: unspecified grants for state-based health insurance exchanges; the Prevention and Public Health Fund ($17.75 billion); construction and capital cost fund for school-based health centers ($200 million); state grants for sex education and other "personal responsibility education" ($75 million); and grants to establish or expand primary care residency programs in teaching health centers ($230 million).

By designating mandatory spending, the law has hamstrung Congress’s ability to address the budget crisis, they said.

“We should fix it,” said Rep. Michael BurgessMichael Clifton BurgessHouse clears bill to raise debt limit Democrats livid over GOP's COVID-19 attacks on Biden Maintaining the doctor-patient relationship is the cornerstone of the U.S. health care system MORE (R-Texas). “It’s within our scope to do so.”

Rep. John Dingell (D-Mich.) said a GOP proposal to make the funding discretionary wouldn’t make it through the Democratic-led Senate, but he said House consideration of it could have a chilling effect on groups applying for reform law funding.

“It might concern them because they might come to the conclusion they don’t want to spend money to put applications together,” Dingell told reporters.

Republicans voted to choke off implementation funding for the reform law in a seven-month spending bill approved by the lower chamber in February. But Democrats have called the defunding measure a non-starter.